Jack's quick post on lack of evidence based practice on the use of fever-control meds was certainly provoking. Sometimes it seems that the information glut is just so over-whelming that one has to be ceaselessly vigilent in order not to be negatively impacted by someone else's lack of diligence. So what to do with making sure that our little (but vital) information base is adequately promulgated? Yesterday, I saw a woman with purulant discharge and bloody milk. Baby has tongue tie, and positioning must have been bad, too, from the looks of the wounds. She was 9 days pp with deep, scabbed over positional stipes, and what looked like impetigo on her left nipple. Way too painful to even try to latch the baby. The little bit of milk we could pump from that breast was clumpy with bloody, pus-y debris. She had spoken with the OB office earlier in the day to describe the red breast. Since the mother had no fever, the RN offered advice about yeast, certainly another illustration of the inherent difficulty in managing lactation by phone. My practice is usually to fax info following a visit, but I call if I feel a crisis is iminent. I was grateful to reach a nurse whom I knew from conf. She was therefore willing to trust my observation and to immed. call in a prescription for an oral antibiotic and a prescription strength anti-fungal/cortisone ointment. She wasn't willing to call in the final ingredient to make a triple action cream (the topical antibiotic). Her fear was the Bactroban (mupirocin) would be dangerous to the baby. My report will be sure to include a ref. or two about triple action nipple creams (from Hale) and the abstract page of Verity Livingston's JHL article about mastitis and ascending impetigo. Full refs: Hale,T: Clinical Therapy in Breastfeeding Patients, Pharmasoft Med Publishing, Amarillo, 1999. Livingston,V: The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A Randomized Comparative Study, JHL 1999; 15(3):241. What we do for a living is teach. We teach moms, and we teach the medical communities in our own home towns. We do this with repitition, sharing materials, reports, networking on boards and committies, and by bringing up breastfeeding in off-topic situations. When I took Lydia to see the rheumatologist, one piece of info I made sure to provide was the length of time she breastfed. When I have my mammograms, I mention the total duration of my lactation history. The importance of including this info whenever health hx material is gathered is partly our resonsibility to emphasize. Kathy Dettwyler is right: We serve as active catalysts for change. Barbara Wilson-Clay, BSEd, IBCLC Austin Lactation Associates http://www.lactnews.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html